Park Chanhyun, Tan Xi, Patel Isha B, Reiff Amanda, Balkrishnan Rajesh, Chang Jongwha
The University of Texas, Austin, TX, USA.
The University of Michigan, Ann Arbor, MI, USA.
J Prim Care Community Health. 2014 Oct;5(4):253-62. doi: 10.1177/2150131914539814. Epub 2014 Jun 25.
A health care reform has been taking place to provide cost-effective and coordinated care. One method of achieving these goals is a patient-centered medical home (PCMH) model, which is associated with provision of quality care among children belonging to racial/ethnic minorities. Despite the potential of the PCMH for children of minority backgrounds, little is known about the extent to which minorities with mental disorders have the PCMH.
The study examined racial/ethnic disparities among children with mental disorders in accessing care from the PCMH.
The 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN) was used for this analysis. Multivariate logistic regressions were applied to capture the racial/ethnic disparities and to analyze a composite outcome of the PCMH.
An estimated population size of 4 677 904 CSHCN with mental disorders was included. Among them, 59.94% of children reported to have received medical homes. Compared with white children, the odds of receiving any medical home services decreased among Hispanic children (odds ratio [OR] = 0.69; P < .05) and black children (OR = 0.70; P < .05). The likelihood of having a medical home was lower for Hispanic children than white children, when they had attention deficit hyperactivity disorder (ADHD; OR = 0.57; P < .05) and development delay (OR = 0.73; P < .05). Compared with white children with ADHD or depression having a medical home, the odds of black children with ADHD (OR = 0.63; P < .05) and depression (OR = 0.68; P < .05) having a medical home were lower.
There were significant racial/ethnic disparities among CSHCN with mental disorders, indicating several sizeable effects of each of the 5 components on Hispanic, black, and other children compared with white children. These differences could be a potential to improve racial/ethnic disparities.
一场医疗保健改革正在进行，旨在提供具有成本效益且协调一致的护理。实现这些目标的一种方法是采用以患者为中心的医疗之家（PCMH）模式，该模式与为少数族裔儿童提供优质护理相关。尽管PCMH对少数族裔背景的儿童具有潜力，但对于患有精神障碍的少数族裔儿童拥有PCMH的程度却知之甚少。
该研究调查了患有精神障碍的儿童在通过PCMH获得护理方面的种族/族裔差异。
本分析使用了2009 - 2010年全国特殊医疗需求儿童调查（CSHCN）。应用多变量逻辑回归来捕捉种族/族裔差异，并分析PCMH的综合结果。
纳入了估计数量为4677904名患有精神障碍的CSHCN。其中，59.94%的儿童报告已获得医疗之家服务。与白人儿童相比，西班牙裔儿童（优势比[OR] = 0.69；P <.05）和黑人儿童（OR = 0.70；P <.05）获得任何医疗之家服务的几率降低。当西班牙裔儿童患有注意力缺陷多动障碍（ADHD；OR = 0.57；P <.05）和发育迟缓（OR = 0.73；P <.05）时，他们拥有医疗之家的可能性低于白人儿童。与患有ADHD或抑郁症的白人儿童拥有医疗之家相比，患有ADHD（OR = 0.63；P <.05）和抑郁症（OR = 0.68；P <.05）的黑人儿童拥有医疗之家的几率更低。
患有精神障碍的CSHCN中存在显著的种族/族裔差异，表明与白人儿童相比，这五个组成部分中的每一个对西班牙裔、黑人及其他儿童都有若干相当大的影响。这些差异可能是改善种族/族裔差异的一个潜力所在。
